Intended for healthcare professionals

Letters Doctors and guidelines

Doctors can depart from guidelines in patients’ best interests

BMJ 2015; 350 doi: (Published 18 February 2015) Cite this as: BMJ 2015;350:h841
  1. Caroline Fryar, head of advisory services1
  1. 1Medical Defence Union, London E14 5GS, UK
  1. dawn.boyall{at}

The Medical Defence Union (MDU) is often asked about the medicolegal implications of guidelines so it might be helpful to clarify our advice.1 Members ask whether they are bound to follow guidelines or whether, after considering an individual patient’s circumstances, it may be appropriate to depart from guidelines.

Guidelines inform clinical practice but don’t dictate it. They do not replace clinicians’ knowledge and skills. Doctors are expected to be familiar with nationally recognised guidelines that are relevant to their specialty, as well as local guidelines. This does not mean they cannot depart from guidance when they consider it to be in the patient’s interests to do so.

Doctors must be prepared to explain and justify their decisions and actions, especially if they depart from guidelines issued by a nationally recognised body. It is also important to keep a record of the reasons for the decision, including any discussions with the patient.

Doctors often worry about what might happen if something goes wrong and there is a clinical negligence claim after treatment that departed from guidelines. Although the demonstration that a doctor followed widely accepted guidance, supported by expert opinion, can help in the defence of a claim, it is equally possible to defend cases where a doctor did not follow guidelines because it was not in the patient’s interests.

MDU members are welcome to contact us if they need specific advice on the use of guidelines.2


Cite this as: BMJ 2015;345:h841


  • Competing interests: None declared.


View Abstract